Vacuum delivery is a device used to assist delivery by creating negative pressure between a suction cup and the fetal scalp. It has a suction cup, vacuum generator, and traction tubing. There are different cup types, including Malmstrom, Bird, and soft silicone cups. Vacuum delivery is indicated for maternal or fetal distress in the second stage of labor or prolonged second stage. Proper technique involves assessing fetal position, applying the cup to the flexion point, gradually increasing negative pressure, and applying traction in sync with contractions along the curve of Carus. Complications can include cephalhematoma and injuries for the baby or soft tissue injuries for the mother.

1. Vacuum
Delivery
Tan Wei Wern
101303117
Group D2

2. Description
• It is an instrumental device designed to assist
delivery by creating a vacuum (negative
pressure) between itself and the fetal scalp.

3. Parts
• Suction cup of variable sizes (30, 40, 50, 60
mm). It is either metallic, or soft (made of
silicone.)
• Vacuum generator.
• Traction tubing.

4. Types
• Malmstrom cup
– A metal cup to its centre attached a metal chain
passed through the rubber tube. The other end of the
chain is attached to a handle for traction.
• Bird’s cup
– The suction rubber tube is attached to the periphery
of the cup while the handle of traction is attached by
a separate short metal chain to the centre of the cup.
• Soft cup
– It is a bell-shaped 6.5 cm diameter soft cup which is
made of a firm but supple silastic material.

5. Malmstrom Cup

6. Bird Cup

7. Soft Cup

8. Kiwi Cup

9. Soft Cup
• Advantage: It produces symmetric, less
cosmetically alarming caput succedaneum and
less scalp abrasions.
• Disadvantage: It slips more than the metal cup
but with less scalp injuries.

10. Indications
• Maternal distress in 2nd stage of labour.
• Fetal distress in 2nd stage of labour.
• Prolonged 2nd stage.
• To shorten the 2nd stage in VBAC.
• For prophylactic use in mothers with
cardiovascular, respiratory, cerebrovascular
disorders.

11. Contraindications
• Fetal prematurity
• Non-vertex presentation, malpresentations
• Fetal scalp trauma
• Unengaged head
• Incomplete cervical dilatation
• Active bleeding/suspected fetal coagulation
defects
• Suspected macrosomia
• Cephalopelvic disproportion

12. Prerequisites
• Bladder must be emptied
• Cervix fully dilated
• No evidence of CPD
• Vertex presentation and not above the station
of +2
• Membranes must be ruptured

13. Technique
• APPLICATION
– Station of the head and its position is assessed
– Instrument is checked to be in working condition
before application
– Selection of the cup is important
– The cup is introduced after retraction of perineum
with two fingers of the other hand

14. – The center of the cup
should be on the flexion
point of the head, which is
a point located on the
sagittal suture, 3cm in front
of posterior fontanelle
– Traction at this point results
in maximum flexion (flexing
median application)

15. Placement Areas
CORRECT
THE REST ARE
INCORRECT
PLACEMENT
AREAS

16. Technique
• NEGATIVE PRESSURE
– The vacuum is created gradually after ensuring that no
soft tissue is included in the cup.
– Once the pressure reaches 0.2kg/cm2, it is rechecked
for inclusion of the soft tissue in the cup.
– The negative pressure is then gradually increased to a
maximum of 0.8kg/cm2 to create a chignon (artificial
caput)
– Following this the traction is applied

17. • Traction should be synchronous with uterine contraction
• Direction of pull should follow curve of Carus
• Traction should be at right angle to the cup
Principles During Traction

18. Principles During Traction
• Counter pressure should
be applied with the left
hand (thumb on the cup,
index finger on the scalp)
to prevent slipping
• Descent should occur
with each pull
• Delivery should occur
within 3 pulls over a
period of 15 minutes

19. Principles During Traction
• If the cup slips, reevaluate the station and
position of the head and reassess the pelvis
• Reapply only when there is no problem
• If it slips again or descent is not satisfactory, the
procedure should be abandoned
• As soon as baby is delivered, the vacuum
pressure is reduced, and cup is detached
• Delivery is completed in the normal way

21. How To Do It

22. Complications
• MATERNAL
– Soft tissue injuries to the vagina, cervix, perineum
– Annular detachment of cervix
– Traumatic postpartum hemorrhage
• FETUS
– Cephalhematoma
– Intracranial hemorrhage
– Subconjunctival hemorrhage
– Retinal hemorrhage
– Fetal asphyxia
– Neonatal jaundice

23. So What Are The Differences?

24. Comparison
Forceps Delivery Vacuum Delivery
Does not require maternal effort Require some maternal effort as need to
synchronize with uterine contraction
Equipment less complex Less expertise required
Less incidences of cephalhematoma More incidences of cephalhematoma
Can be used in preterm Cannot be used in preterm
Can be used in non-cephalic
presentations
Can be used in partially-rotated head. Not
used in non-cephalic presentations.
Less injuries to infant, higher morbidity
for mother
Less maternal injuries, higher morbidity
for infant
Need for anesthesia/analgesia No need for anesthesia
Takes less time in fetal distress, quicker
delivery
Higher failure rate

25. THANK YOU

26. • Manual for Practical Obstetrics and
Gynecology, 1st Edition. Dr Somsubhra De, Prof
Dato Dr Sachchithanantham.
Reference